Abstract 14259: Eosinophilic Granulomatosis Presenting as Non-ST Segment Elevation Myocardial Infarction

Abstract

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis characterized by small to medium size vessel vasculitis. Here, we present a case of newly diagnosed EGPA presenting as non-ST segment elevation myocardial infarction (NSTEMI). Case: A 53-year-old male with a history of asthma and nasal polyps presented with acute onset anginal chest pain, rising troponin T and CKMB without ischemic changes on electrocardiogram. He was admitted for NSTEMI. Cardiac catheterization showed non-obstructive coronary artery disease (Figure 1). Given his past medical history along with eosinophilia and pulmonary opacities seen on CT chest, there was concern for EGPA. Lung wedge resection biopsy showed parenchymal eosinophilia, granulomatous inflammation, and vasculitis that confirmed the diagnosis (Figure 2). Figure 1 Figure 2 Discussion: Cardiac involvement is known to be a major contributor to disease-related death, totaling up to 50% of cases, and therefore poses an important aspect of this rare disease. Recent reports, particularly concerning clinical differences given ANCA status, have shown that these patients might represent a heterogeneous group. For instance, ANCA-negative patients, such as our patient, more frequently develop heart conditions. We cultivate such discussion not only to bring attention to EGPA as an uncommon entity to the practice of many cardiologists, but also to point out that early recognition of cardiac involvement could reduce morbidity and mortality.